Healthcare Provider Details

I. General information

NPI: 1205562758
Provider Name (Legal Business Name): MARIANGELY IRIZARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO VACAS SALTILLO CARR 518 R388 KM 0.2
ADJUNTAS PR
00601
US

IV. Provider business mailing address

PO BOX 676
ADJUNTAS PR
00601-0676
US

V. Phone/Fax

Practice location:
  • Phone: 939-441-1899
  • Fax:
Mailing address:
  • Phone: 939-441-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number007642
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier007642
Identifier TypeOTHER
Identifier State
Identifier IssuerSPEECH THERAPIST

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: